European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2022
Multicenter StudyInterobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons.
Atlas (C1) fractures are commonly rated according to the Gehweiler classification, but literature on its reliability is scarce. In addition, evaluation of fracture stability and choosing the most appropriate treatment regime for C1-injuries are challenging. This study aimed to investigate the interobserver reliability of the Gehweiler classification and to identify whether evaluation of fracture stability as well as the treatment of C1-fractures are consistent among spine surgeons. ⋯ We found a moderate reliability for the Gehweiler classification and for the evaluation of fracture stability. In particular, diverging treatment strategies for type 3b fractures emphasise the necessity of further clinical and biomechanical investigations to determine the optimal treatment of unstable C1-fractures.
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Eur J Trauma Emerg Surg · Feb 2022
The efficiency and safety of intravenous tranexamic acid administration in open reduction and internal fixation of pelvic and acetabular fractures.
This study aimed to investigate the efficiency and safety of tranexamic acid use in open reduction and internal fixation of pelvis and acetabulum fractures. ⋯ Use of TXA in pelvic and acetabular fractures was found to be effective in reducing total blood loss, hemoglobin drop and transfusion rates without increasing venous and pulmonary thromboembolism in our series.
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Eur J Trauma Emerg Surg · Feb 2022
Simplified Kirschner‑wire-based dynamic external fixator for unstable proximal interphalangeal joint fractures.
Ligamentotaxis is a well-established treatment modality for treating challenging articular fractures. Many devices have been evolved to apply this principle to complex proximal interphalangeal joint (PIPJ) fractures. Although they gave satisfactory results, these devices were sometimes costly, complex and cumbersome. The aim of this study was to evaluate the short-term functional and radiological outcomes of treating complex intra-articular PIPJ fractures using a simplified, preloaded Kirschner‑wire (K‑wire)-based dynamic external fixator. ⋯ The used fixator technique is simple, reliable, available, reproducible, time-saving and cost-effective for managing complex PIPJ fractures while allowing early joint mobilization, which proven effective in achieving high satisfactory functional results.
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Eur J Trauma Emerg Surg · Feb 2022
Perfusion indices can predict early volume depletion in a blood donor model.
Blood donation from healthy donors is used experimental model that surrogates for class 1 hemorrhage in humans. We examined changes in the perfusion index (PI) and plethysmographic variability index (PVI) in healthy blood donors after donating a unit of blood, and we evaluated the usability of these indices in detecting blood loss volumes of less than 750 mL (class 1 hemorrhagic shock trauma patients). ⋯ We evaluated the perfusion indices in the early diagnosis of blood volume loss in patients admitted to the emergency department due to trauma. After the participants donated one unit of blood, we found that their PI decreased and PVI increased compared to the measurements before the blood donation. Considering that major bleeding starts in the very early stage as minor bleeding, it is essential for emergency physicians to recognize class 1 hemorrhagic shock patients. Further, non-invasive and straightforward procedures, such as measuring PI and PVI, can be particularly useful in identifying blood loss volumes of less than 750 mL.
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Eur J Trauma Emerg Surg · Feb 2022
Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES 'snapshot audit' of practice.
Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level. ⋯ This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich 'real world' insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study.